Does gateway offer Medicare or Medicaid plans?
Gateway Health offers HMO plans with a Medicare Contract. Some Gateway Health plans have a contract with Medicaid in the states where they are offered. Enrollment in these plans depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information.
What is Gateway Health Medicare assured Ruby?
Gateway Health Medicare Assured Ruby is a Medicare Advantage Special Needs Plan created for individuals who are eligible for both Medicare and Medicaid. This plan offers $0 premium* and $0 to low copay options to ensure that you get the care you need -- when you need it.
How will the Gateway Health Medicare assured Diamond partnership impact me?
You can find out how this partnership will impact you here. Gateway Health Medicare Assured Diamond is created for Medicare beneficiaries who are on a fixed income and eligible for full Medicaid benefits. These plans include significant $0 copay options to ensure that health plan members can access the care you need when you need it.
What are the different types of gateway health plans?
If you’re eligible for both Medicaid and Medicare, we offer two types of complete plans - the Ruby Plan and the Diamond Plan. As a Gateway Health plan member, you’ll get access to our team of helpful problem solvers, and all kinds of different benefits and programs to help make your life better. Here are some our most popular benefits:
Is Gateway owned by Highmark?
PITTSBURGH (September 7, 2021) — Highmark announced today it has closed on its transaction to acquire full ownership of Gateway Health Plan, Inc. (Gateway Health), a leading managed care organization dedicated to caring for the total health of its members following receipt of the necessary state regulatory approvals.
Can you bill a Medicaid patient if you are not a participating provider in Pennsylvania?
Generally, the only time a provider can bill a Medicaid recipient for a service is if the service is not covered by Medicaid, the provider informed the consumer of this ahead of time, and the consumer consented to paying for the non‐covered service out‐of‐pocket.
Can I use PA Medicaid out of state?
Can I use my Medicaid coverage in any state? A: No. Because each state has its own Medicaid eligibility requirements, you can't just transfer coverage from one state to another, nor can you use your coverage when you're temporarily visiting another state, unless you need emergency health care.
Can you have both Medicare and Medicaid in Pennsylvania?
That's right – you can have both Medicare and PA Medicaid at the same time! Whether you can benefit from both programs or just one, this guide can help you determine whether or not Pennsylvania Medical Assistance can provide the healthcare insurance you need.
How do I request an exception to the Gateway Health Medicare Assured Drug List (Formulary)?
For more information or questions on how to use the formulary exception process or to request a formulary exception, please contact Member Services by using the phone number on your ID card or click here
What time does Gateway Health override?
In this situation, have the out-of-network pharmacy call the Gateway Health Medicare Assured Pharmacy Services Department at the following numbers to obtain an out-of-network pharmacy override: 8:00 AM - 8:00 PM Eastern Time 7 Days a week from October 1 through March 31.
Are there any drugs that are excluded from coverage?
Our Plan cannot cover a drug purchased outside the United States and its territories.
What if my drug is not on the Drug List (Formulary)?
If your drug is not included on this formulary, you should first contact Customer Services and ask if your drug is covered. If you learn that Gateway Health Medicare Assured does not cover your drug, you have two options:
Are my Part D drugs covered if I go to an out-of-network pharmacy?
Generally, we cover drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy.
How many Pharmacies are in the Network?
Gateway Health Medicare AssuredSM has over 3,000 pharmacies in its network. Gateway has contracts with pharmacies that equal or exceed the Centers for Medicare and Medicaid Services (CMS) requirements for pharmacies in your area. Get a listing of pharmacies in your area .
How far am I into the coverage gap (also referred to as the “donut hole”)?
Your TrOOP (True-Out-Of-Pocket) status, including your total drug spend towards your coverage gap (donut hole) can be found on your most recent explanation of benefits (EOB). If you are unable to locate your most recent EOB or have additional questions about this amount, please call the number listed on the back of your card.
What is Gateway Health Medicare?
Gateway Health Medicare Assured Ruby is a Medicare Advantage Special Needs Plan created for individuals who are eligible for both Medicare and Medicaid. This plan offers $0 premium* and $0 to low copay options to ensure that you get the care you need -- when you need it.#N#* Depending on your level of Medicaid eligibility and/or level of Extra Help
Is Gateway Health part of Highmark?
Gateway Health is now part of the Highmark family! We will continue to provide health care to serve the whole you. You can find out how this partnership will impact you here.
Does Gateway Health have a Medicare contract?
Gateway Health offers HMO plans with a Medicare Contract. Some Gateway Health plans have a contract with Medicaid in the states where they are offered. Enrollment in these plans depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium – The State pays the Part B premium for full dual members. Please contact the plan for further details. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
How often does Medicare evaluate plans?
Every year, Medicare evaluates plans based on a 5-star rating system.
How to contact Medicare by phone?
For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048) , 24 hours a day/7 days a week or consult www.medicare.gov.
What is Medicare Advantage?
Medicare Advantage plans are an alternative way to get your Original Medicare. These plans help cover the costs of services provided by hospitals, doctors, lab tests and some preventive screenings. These plans' prescription drug component helps cover medications. Even if a plan's monthly premium is $0, you would still pay the Original Medicare Part B premium, and Part A premium if applicable, to have medical coverage.
What is Medicare Supplement?
Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and , in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.
Who may contract with other plan sponsors?
Pharmacies, Physicians, and Providers may also contract with other Plan Sponsors.
Do you have to have Medicare Part A or Part B?
You must have Medicare Part A or Part B (or both) to join a Medicare Prescription Drug plan. Members may enroll in the plan only during specific times of the year. Contact the plan for more information.
Is Gateway Health part of Highmark?
Gateway Health is now part of the Highmark family! We will continue to provide health care to serve the whole you. You can find out how this partnership will impact you here.
Does Gateway Health have a Medicare contract?
Gateway Health offers HMO plans with a Medicare Contract. Some Gateway Health plans have a contract with Medicaid in the states where they are offered. Enrollment in these plans depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information.
